Hard to Swallow?

By Laurance, Jeremy | The Independent (London, England), April 1, 2008 | Go to article overview
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Hard to Swallow?


Laurance, Jeremy, The Independent (London, England)


Cough medicines aimed at toddlers are about to go behind the counter. But do any of them actually work? Jeremy Laurance investigates

A cough is usually a minor irritation. But when it becomes persistent and keeps you or your children awake at night it can be distressing, debilitating and drive you to desperate measures. At these times, parents turn to cough medicines to soothe their spluttering infants - and in some cases, dose them too heavily.

This is what sparked last week's decision by the Medicines and Healthcare products Regulatory Agency (MHRA) to remove six cough medicines aimed at the under-twos from the open pharmacy shelves, so that parents can be advised about their proper use. But are cough medicines any use? And what is the best way to treat a cough?

A cough is a vital reflex action. It clears the airway of any blockage. It often develops in response to inflammation from a viral infection. It may be a symptom of flu, a cold, asthma, bronchitis or whooping cough. It may also occur in response to certain medicines and, rarely, as a symptom of lung cancer, tuberculosis or heart failure.

Most coughs clear up on their own after a couple of weeks. If you have had one for more than two weeks following a viral infection, it may be time to see your GP.

Coughs are usually labelled dry or chesty. A dry cough is usually felt in the throat as a tickle and does not produce phlegm or mucus. A chesty cough occurs when phlegm is produced in response to the infection. The cough helps clear phlegm from the lungs. But it may also be unproductive, when the passageways in the lungs become inflamed.

There is no way of getting rid of a cough caused by a virus. But you can treat symptoms of the virus with paracetamol or ibuprofen to reduce fever and ease aches - and the cough.

The basic ingredients of all cough medicines are demulcents - glycerine, honey and syrup that coat the throat and ease irritation. Other compounds - suppressants, expectorants and decongestants - have different actions. There is little evidence that cough medicines work, and they only contain small amounts of active ingredients. A soothing drink or boiled sweet may prove just as effective.

Cough suppressants suppress the cough reflex. They include pholcodine, dextromethorphan and antihistamines, and should only be used for dry coughs. Antihistamines can be helpful at night because they assist sleep. Some parents use older allergy medicines, such as Piriton, with their children for this reason (newer antihistamines don't cause drowsiness). Any medicine causing drowsiness should be used with care during the day, and avoided if driving.

Expectorants include ammonium chloride, sodium citrate, guaiphenesin and ipecacuanah, which help bring phlegm up so coughing is easier.

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